ЦЕЛЬ ИССЛЕДОВАНИЯ Проанализировать функциональные результаты использования свободного кожно-мышечного, химерного, реиннервированного аутотрансплантата для реконструкции языка после субтотальной и тотальной глоссэктомии. МАТЕРИАЛ И МЕТОДЫ В проспективное исследование включено 32 пациента в возрасте от 34 до 68 лет (средний возраст 49,6±11,1 года). Во всех случаях была диагностирована местно-распространенная форма опухолевого заболевания полости рта (III—IVA, B стадии). В качестве реконструктивно-пластического этапа хирургического лечения был использован разработанный в МНИОИ им. П.А. Герцена метод микрохирургической реконструкции языка. Анализ функциональных показателей проведен с учетом сроков восстановления питания естественным путем, деканюляции и восстановления функции речеобразования. РЕЗУЛЬТАТЫ Питание естественным путем было восстановлено у 25 (83,4%) пациентов. При этом у такого же количества пациентов была произведена деканюляция, из них у 6 (25%) в течение 20—30 сут, у 15 (60%) больных — 1—3 мес и у 4 (16%) более чем через 3 мес со дня операции. Функция речеобразования была восстановлена в 73,4% случаев. Подавляющее большинство пациентов — 26 (81,3%) — вели активный образ жизни после лечения и не требовали постороннего ухода за собой. Вернулись к труду 32% пациентов в группе трудоспособного возраста. ЗАКЛЮЧЕНИЕ Кожно-мышечный, химерный, реиннервированный аутотрансплантат из бассейна подлопаточной артерии представляет собой безопасный и надежный лоскут для реконструкции языка после спасительных операций с удовлетворительными функциональными результатами.

66 В структуре общей заболеваемости злокачественными опухолями рак гортани составляет 1,19%. В 2016 г. в России впервые выявлено 7148 новых случаев злокачественных опухолей гортани, 3852 больных умерли. Средний возраст умерших составил 63,7 года [1]. Впервые выявленный рак гортани III стадии составил 40,6%, IV стадии — 19,1%. Летальность на первом году от момента установления диагноза при поражении гортани составляет 23,6% [2]. За последние годы достигнуты большие успехи в области консервативной хирургии опухолей гортани, разработаны новые протоколы лечения для сохранения органа с химиотерапией и лучевой терапией. В настоящее время наблюдается тенденция к резервированию хирургии в качестве процедуры спасения после неудачи других способов лечения рака гортани [3]. Среди злокачественных образований данной локализации доля эпителиальных опухолей составляет около 90%. У 60—80% больных имеются регионарные метастазы, в 50% случаев рецидивы возникают в течение 1-го года наблюдения [4]. У значительного количества пациентов отмечается радиохимиорезистентность опухолей. Лечение пациентов с рецидивными опухолями возможно только при хирургическом вмешательстве. При местно-распространенном рецидиве рака гортани после лучевой терапии на сегодняшний день операцией выбора остается лишь тотальная ларинг эктомия [5]. Первое удаление гортани было произведено в 1873 г. С этого момента возникла необходимость поиска заместительного механизма для образования голоса [6]. Поскольку потеря голосового органа или, другими словами, потеря нормального словесного общения является самым серьезным последствием ларингэктомии у многих пациентов. Голос играет важную роль в самосознании. В результате пациенты могут рассматривать потерю голоса как потерю части их самосознания. Современные речевые реабилитационные системы облегчают комплексную реабилитацию после ларингэктомии, так как они включают теплообменники и автоматические клапаны трахеостомы, которые позволяют проводить как голосовую, так и легочную реабилитацию у ларингэктомированных пациентов [7]. Способы голосовой реабилитации подразделяют на три вида: пищеводный голос, электрогортань и голосовое протезирование (рис. 1). Трахеопищеводное шунтирование с использованием голосового протеза рассматривается как «золотой стандарт» для голосовой реабилитации пациентов с карциномой гортани, которым выполнена полная ларингэктомия. Достаточно часто после установки голосового протеза могут возникать такие неприятные явления, как инhttps://doi.org/10.17116/onkolog2018705166

Background . Combination therapy is the main method used for treatment of patients with locally advanced cancer of the oral floor and tongue. Radical surgery is a key stage of this therapy. These surgeries are inevitably associated with extensive defects in the oral cavity and tongue and, therefore, the loss of necessary organism functions. Currently, there is no optimal autotransplant for tongue reconstruction after total or subtotal removal of the tongue and oral floor muscles; it appears to be one of the most significant challenges in modern reconstructive surgery. Materials and methods. The authors describe a case of successful repair of the oral floor and tongue after total glossectomy using a novel method developed in the Department of Microsurgery at the P. A. Herzen Moscow Oncology Research Institute – branch of the National Medical Research Radiology Center, Ministry of Health of Russia. This method implies tongue reconstruction using a revascularized, reinnerved, chimeric, thoracodorsal flap with inclusion of a muscular portion from the serratus anterior muscle and a musculocutaneous portion from the latissimus dorsi muscle. We performed tongue reconstruction in a 62-year-old patient diagnosed with stage IVA (Т3N2bМ0) tongue cancer. Results. The novel method of surgical treatment of locally advanced tongue cancer with simultaneous repair of defects using a revascularized, reinnerved, chimeric flap with inclusion of the serratus anterior muscle and latissimus dorsi muscle allowed to remove the tumor, stabilize the laryngeal complex, restore the diaphragm of the oral floor, create an adequate volume of neotongue, obtain good functional and cosmetic results, and reduce the length of hospital stay. Conclusion. Novel method of surgical treatment of locally advanced tongue cancer facilitates health, employment, and social rehabilitation of patients with oropharyngeal cancer. This method can be considered as an alternative method of choice in the reconstruction of complex post-traumatic oropharyngeal defects.

Objective: To improve the outcomes of patients rehabilitation after surgical treatment of local larynx tumors with restoration of the upper part of gastrointestinal tract and vocal function. Materials and methods: Voice prostheses were installed in 243 patients after laryngectomy. Pharyngoplasty with displaced pre-fabricated pectoris flap was performed in 16 patients, voice prosthesis was installed in 9 of them. Reconstruction of pharynx and cervical part of esophagus with visceral flaps was performed in 94 cases, voice prosthesis was installed in 19 of them. Autotransplantation of ilea-colon flap was performed in 1 case, thus providing restoration of digestive and vocal without any prosthesis. This article presents clinical cases of delayed pharyngoplasty with pre-fabricated pectoris flap and visceral flap with installation of voice prosthesis and a case of ilea-colon flap reconstruction. Results: In the group of patients after laryngectomy and voice prosthesis installation, 85% of voice rehabilitation cases were successful, 15% of patients had a spasm of pharynx constrictor muscle, and this required myotomy to be performed. Mouth nutrition after pharyngoplasty with pectoris flap was restored in 94% of patients. 77% of patients had satisfactory speech function after the prosthesis installation. Salivary fistula were observed in 19% of the cases, neck wound maturation – in 6%, flap necrosis – in 6% of the cases. Mouth nutrition after pharyngoplasty with visceral flaps was restored in 94.6% of patients. 84% of patients have good speech generation after prosthesis installation. Salivary fistulas were observed in 8.7% of cases, neck wound maturation – in 6.5% of cases, flap necrosis – in 5.4% of cases. Conclusion: Voice prosthesis installation is possible in patients after all types of pharyngoplasty, except for gastroepiploic flap. The choice of flap for the reconstruction of the upper digestive tract depends on the general condition of the patient, on concomitant pathology, on the state of the donor organs and tissues, on previous surgical intervention on the abdominal organs, and the capabilities of the department.

AIM To improve immediate and long-term results of delayed coloesophagoplasty in cancer patients. MATERIAL AND METHODS We presented three case reports of coloesophagoplasty in difficult clinical situations including technical impossibility of primary plasty, extraordinary anesthetic situation, transplant necrosis after primary plasty. RESULTS Gastrointestinal tract integrity was restored in all cases and patients returned to nutrition per os, that provided good quality of life and compensated nutritional deficiencies. Only one patient had bleeding in postoperative period that required relaparotomy. There were no postoperative complications in two other patients. CONCLUSION Delayed coloesophagoplasty should be performed in all patients who underwent esophagogastrectomy if progression of primary disease is absent. Graft placement and colic segment are chosen individually. However left half of colon with retrosternal location of transplant is preferable for plasty.

A surgical approach as dysmasking implies a bitemporal skin incision followed by a single flap from upper facial soft tissues. The advantages of this technique may include a wide surgical approach to the structures of the anterior skull base, a possibility of intraoperative extension of the approach through parapalpebral and/or pre-auricular incisions, the lack of incisions in the central zone of the face, the preservation of the integrity of mimic muscles and the sensitivity of soft tissues in the central zone of the face. This paper gives experience in surgically treating 5 patients with malignant tumors of the paranasal sinuses and skull base. All the cases required a wide approach to the skull base and anterior facial skeleton. This was achieved by the use of the dysmasking approach, if need be, parapalpebral incisions or facial nerve resection followed by single-stage microsurgical neurorrhaphy were made. All operations were performed under endotracheal anesthesia. The wide surgical approach to the tumor, which permitted its removal in the maximum volume without skin incisions in the central zone of the face, as vitally indicated, could be achieved by dysmasking that yielded satisfactory postoperative cosmetic and functional results in all the cases.

After surgical treatment for locally advanced oral tumors with resection of soft tissues, mucosal membrane, and facial skeletal structures, there are penetration combined defects, removal of which is a challenge for reconstructive surgeons. Mandibular repair is one of the problems in the correction of combined oral defects. Surgeons use different grafts to remove mandibular defects. One-flap transplantation does not always solve all reconstruction problems and ensure the repair of the mucosal membrane, a soft-tissue component, skin integuments, and facial skeleton.The authors describe a clinical case of successful single-stage correction of penetration combined orofacial defect after resection of the tongue, mouth floor, en bloc resection of the lower jaw and mental soft tissues, bilateral cervical supramyochoroidal lymphadenectomy, stage LCL CM mandibular defect formation after J. Boyd, by using two microsurgical autografts (a peroneal skin-muscle-skin autograft and a radial skin-fascia one) in a 39-year-old female patient clinically diagnosed with carcinoma of the left mandibular alveolar ridge mucosa, Stage IVA (T4аN0M0).The Department of Microsurgery, P.A. Herzen Moscow Oncology Research Institute, Ministry of Health of Russia, has gained experience in comprehensively correcting extensive combined maxillofacial defects with two or more grafts in 27 patients who underwent autografting with a total of 73 flaps. The most functionally incapacitating and life-incompatible defect was removed at Stage 1 of reconstructive treatment. Delayed reconstruction was made after a complex of specialized antitumor therapy and assessment of treatment results in the absence of progressive growth. A great problem during multi-stage defect correction is presented by the lack of recipient vessels after cervical lymphadenectomy, the presence of soft tissue scar changes, trismus, temporomandibular joint ankylosis, contractures and displacement of the edges of the resected mandible, and autografting into the chronically infected area.Single-stage repair, including that using a few microsurgical autografts, is the operation of choice for adequate anatomic and functional rehabilitation, permits the promptest recovery of patients, reduces a postoperative period, and allows them to undergo an antitumor treatment cycle. However, the repair is possible, when the risk of disease progression is low, in specialized centers and when there are trained head and neck surgery and reconstructive microsurgery specialists and anesthesiologists.

Sarcomas in the head and neck are rare, and account for approximately 5-15% of all sarcomas in adults, is less than 1% of all neoplasms of the head and neck. Due to anatomical and physiological features of the structure of the nasopharynx, surgical treatment of tumors of this localization is associated with a number of technical difficulties, the high risk of non-radical removal of the tumor, it was therefore necessary for adequate surgical access. The article describes video-assisted access for removal of tumors of the nasopharynx with good visualization of the tumor process simultaneously after laryngectomy with the formation of pharyngotomy, providing the opportunity to monitor the postoperative area of the nasopharynx and early detection of continued tumor growth in patients with soft tissue sarcoma of the nasopharynx and combined lesions of the larynx.